Next Generation ACO

For organizations experienced in population health, the Medicare Next
Generation ACO model offers greater opportunities for financial risk and reward.
Participants can use payments for incentives, infrastructure, and
revenue-sharing.

Here are two examples.

UnityPoint Health: Next Gen as a Logical Next Step

MACRA and the promise of 105 million patients by 2020 drew UnityPoint Health
to the ACO model, Aric Sharp, vice president of Unity Point Accountable Care,
told attendees at AMGA’s annual conference. After Pioneer ACO and MSSP
participation, a number of other factors led the organization specifically to
the Next Gen model, including:

Prospective, rather than retroactive, patient attribution

80% risk sharing

Waivers in areas like skilled nursing, telehealth, and home visits

The opportunity to collaborate with peers and the Center for Medicare and
Medicaid Innovation (CMMI) as the ACO model evolves

UnityPoint Health had 84,000 lives in its Next Gen ACO and $1 billion in
medical spend in agreements with downside risk. To guide its clinical
transformation, it created its own trademarked care model. This model is
grounded in five foundational processes (common care plans, clinical care
pathways, care transitions, and utilization and referral management) and guides
the use of analytics, risk stratification, platforms, and services across the
organization.

For success in the Next Gen ACO model, Sharp advised:

Spreading risk out over a sufficient volume of lives, and keeping care within
network to better manage costs

Prioritizing physician training and coaching to manage change and reduce
outliers and variations in care

Focusing on risk coding, and on favorable and fair contract terms. “Work on
sharing risk with your network partners in amounts that are both meaningful and
palatable.”

Trinity Health: Making the Right Thing the Easiest Thing

When sharing Next Gen ACO success stories at a recent AMGA conference,
Barbara Walters, executive vice president and chief population officer of
Trinity Health, relayed the story of Rodney, a 54-year-old patient. Before care
through the ACO program, Rodney visited the ER 80 times over a 10-month period
for pain, numbness, nausea, and stroke-like symptoms.

Then a care manager met with Rodney. Discovering behavioral health and
socioeconomic components to Rodney’s illnesses, the care manager referred him to
specialists in behavioral health and pain management, as well as medical
services. This helped him achieve compliance with his appointments and
medications and gain coping mechanisms for his anxiety disorder. After these
interventions, Rodney only visited the ER twice over a two-month period.

Trinity Health, a 22-state diversified network, began its three-year Next-Gen
ACO journey in 2016 as a move to replace its Medicare Shared Savings Program
with an enhanced model similar to Medicare Advantage. The organization set up
Trinity Health ACO (THACO) as a separate legal entity, working through five
participating organizations that it refers to as “chapters.”

The Next Gen ACO model aligns with Trinity Health’s mission, “making the
right thing to do the easiest thing to do,” Walters said. The Next Gen ACO model
removes the perverse incentives and limitations of the fee-for-service world by
refocusing care teams on the patient’s needs at and away from the visit.

Next Gen ACO Lessons Learned

Given the variety of Medicare beneficiaries in THACO’s attributed population,
success has depended on its five chapters working together to:

Understand aligned beneficiaries and their clinical conditions

Implement resources for care management

Use data and analytics to understand and measure performance, then share best practices in population health